Since emergency department (ED) visits present an opportunity to deliver brief interventions to reduce violence and alcohol misuse among urban adolescents at risk of future injury, this study examined the effectiveness of brief interventions that address violence and alcohol use among adolescents presenting to an urban ED.
Between September 2006 and September 2009, 3,338 patients ages 14 to 18 years old who presented to a level I ED in Flint, Michigan, between 12 pm and 11 pm 7 days a week completed a computerized survey (43.5 percent male; 55.9 percent African American). Adolescents who reported past-year alcohol use and aggression were enrolled in a randomized controlled trial (SafERteens). In the intervention, all patients underwent a computerized baseline assessment and were randomized to a control group that received a brochure (n - 235) or a 35-minute brief intervention delivered by either a computer (n - 237) or therapist (n - 254) in the ED, with follow-up assessments at 3 and 6 months. Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included a review of goals, tailored feedback, decisional balance exercise, role plays, and referrals. Self-report measures included peer aggression and violence, violence consequences, alcohol use, binge drinking, and alcohol consequences. About 25 percent (n - 829) of screened patients had positive results for both alcohol and violence; 726 were randomized. Compared with controls, participants in the therapist intervention showed self-reported reductions in the occurrence of peer aggression (therapist, -34.3 percent; control, -16.4 percent; relative risk [RR], 0.74; 95 percent confidence interval [CI], 0.61-0.90), experience of peer violence (therapist, -10.4 percent; control, +4.7 percent; RR, 0.70; 95 percent CI, 0.52-0.95), and violence consequences (therapist, -30.4 percent; control, -13.0 percent; RR, 0.76; 95 percent CI, 0.64-0.90) at 3 months. At 6 months, participants in the therapist intervention showed self-reported reductions in alcohol consequences (therapist, -32.2 percent; control, -17.7 percent; odds ratio, 0.56; 95 percent CI, 0.34-0.91) compared with controls; participants in the computer intervention also showed self-reported reductions in alcohol consequences (computer, -29.1 percent; control, -17.7 percent; odds ratio, 0.57; 95 percent CI, 0.34-0.95). The overall conclusion is that among adolescents identified in the ED with self-reported alcohol use and aggression, a brief intervention resulted in a decrease in the prevalence of self-reported aggression and alcohol consequences. (publisher abstract modified)